Provider Demographics
NPI:1275755241
Name:VALIULLAH, FEHMIDA M (PT)
Entity Type:Individual
Prefix:
First Name:FEHMIDA
Middle Name:M
Last Name:VALIULLAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17572 W. BRIDLE TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-1649
Mailing Address - Country:US
Mailing Address - Phone:847-263-1516
Mailing Address - Fax:847-263-1516
Practice Address - Street 1:17572 W. BRIDLE TRAIL RD
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-1649
Practice Address - Country:US
Practice Address - Phone:847-263-1516
Practice Address - Fax:847-263-1516
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics